Tuesday, 5 October 2010

Quality Standard for CKD

The National Institute for Health and Clinical Excellence (NICE) have issued a draft Quality Standard for Chronic Kidney Disease covering the whole CKD care pathway and supported by 14 quality statements. The statements range from early detection of those at risk, specialist assessment, planning for dialysis and transplantation to experience of care including transport for those receiving hospital or satellite based haemodialysis.

  1. People with risk factors for CKD are offered testing and people with CKD are correctly identified.
  2. People with CKD are assessed for disease progression and associated complications.
  3. People with CKD are defined at risk groups are referred for specialist assessment in accordance with NICE guidelance.
  4. People with diabetes and microalbuminuria and people with higher levels of proteinuria are enabled to maintain their systolic blood pressure within a target range 120-129 mmHg and their diastolic blood pressure below 80 mmHg.
  5. People with anaemia of CKD are offered anaemia therapy in accordance with NICE guidance if they are assessed as being likely to benefit in terms of quality of life, physical function or avoidance of blood transfusion.
  6. People presenting with acute kidney injury have their medication reviewed and receive an assessment of volume status, multistix reagent strip urinalysis, and an assessment of renal morphology and the presence or absence of obstruction.
  7. People with progressive CKD whose eGFR is less than 20 ml/min/1.73M2 or who are likely to progress to established kidney failure within 12 months receive timely and balanced personalised information on established kidney failure and renal replacement therapy options.
  8. Where clinically indicated, people with established kidney failure start dialysis with a functioning Arteriovenous fistula or peritoneal dialysis catheter in situ.
  9. People with CKD are immunised against infection in accordance with current policy.
  10. People under the care of renal services have their risk of healthcare associated infection minimised.
  11. People with CKD receiving haemodialysis or training for home therapies who are eligible for transport, have access to an effective and efficient transport service.
  12. Medically suitable people with CKD are supported to receive a pre-emptive kidney transplant before the need for dialysis.
  13. People with CKD have a current agreed care plan appropriate to their stage and rate of progression of CKD.
  14. People with CKD needing end of life care or conservative management of established kidney failure, have a jointly agreed advance care plan and access to all non-dialytic medical care for their CKD.

Each of the statements is accompanied by quality measures with definitions, numerators and denominators so that service quality can be assessed and improvements targeted to where they are most needed for the local population. For instance the proportion of people with CKD who need end of life or conservative management of established kidney failure who have a jointly agreed advanced care plan or the proportion of people who start haemodialysis with a functioning arterovenous fistula. Simple measures such as the proportion of medically suitable people with CKD who receive a pre-emptive transplant before the need for dialysis have been chosen so that they are easy to understand and measure.

The quality standard also describes what each statement means for patients, what service providers should do, the role of healthcare professionals and what specification commissioners of care should expect.

The CKD standard will form the basis of future clinical audits and quality improvement schemes. It is likely to link directly to the Outcomes Framework (LINK TO BLOG), an integrated approach to the provision of kidney care is emphasised throughout.

Have a look and have your say on these 2 key questions:

  1. Have NICE identified all appropriate outcomes for each individual quality statement?
  2. Can you suggest any appropriate outcome measures which you feel would illustrate whether this standard as a whole has been achieved?

The consultation is open until 1700 on 10 November 2010.